Sleeping pills

By Dr Simon Kyle

Sleeping pills are some of the most commonly prescribed medications; indeed approximately 12 million units are prescribed in the UK each year. Recent results from the Great British Sleep Survey indicated that 12% of those with chronic poor sleep currently take prescribed sleeping pills. With mounting evidence of their residual daytime side-effects and potential for long-term negative effects on health, it is becoming increasingly common for people to seek out alternative sleep aids in an attempt to improve their poor sleep.

Undoubtedly, pills can help people get to sleep, but they may not work long-term. Consequently, UK and international guidelines recommend that sleeping pills are only prescribed for short-term (a few weeks), or occasional use. They are not advised for people with a persistent sleep problem that has lasted for many months or years.

'Off-label prescriptions'

Sometimes people are given medications that are intended for another purpose but that, as a side-effect, cause drowsiness, making them suitable to be used as a sleep aid. These drugs might be anti-depressant drugs (intended for people who are depressed) or anti-histamine drugs (used to treat allergic reactions).

Antihistamines affect a neurotransmitter, a chemical messenger in the brain, called 'histamine' which works to promote wakefulness. In particular, a group of antihistamines known as 'first-generation antihistamines' have the effect of making some people feel sleepy by blocking histamine receptors in the brain. In contrast, anti-depressant drugs may be prescribed by doctors, either when poor sleep is believed to be a consequence of depression or, alternatively, for the sedative properties of a number of anti-depressant drugs. These medications may aid sleep through effects on serotonin, histamine or melatonin.

This is known as 'off-label prescribing' and some doctors prefer these kinds of drugs because they can prescribe them on a longer term basis.

Prescription sleeping pills

Nowadays, there are some drugs specifically licensed as sleeping pills. These include drugs known as benzodiazepines which were originally developed to treat anxiety (often ending with the suffix '-epam' [e.g. temazepam]), and a similar group (often beginning with the letter 'Z', e.g. zopiclone) which are a bit less habit forming, though they act on the same brain receptors These brain receptors, called GABA receptors, respond to the neurotransmitter, gamma-amino butyric acid (GABA), which is involved in the inhibition of arousal and promotion of sleep. Interestingly, there have been recent scientific reports that, in some patients with insomnia, there is a reduction in the levels of brain-GABA compared with normal sleepers.

Although not strictly a sleeping pill, melatonin (a hormone involved in the regulation of our body clock, and sleep-wake rhythms) is available on prescription for adults over 55 with chronic insomnia.

In every case you should follow your doctor's advice with regard to medication – starting, changing or finishing a course of medication can have serious effects. Ensure that you consult your GP if you have any questions on this.